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- Title
Coronavirus Disease 2019 Convalescent Plasma Outpatient Therapy to Prevent Outpatient Hospitalization: A Meta-Analysis of Individual Participant Data From 5 Randomized Trials.
- Authors
Levine, Adam C; Fukuta, Yuriko; Huaman, Moises A; Ou, Jiangda; Meisenberg, Barry R; Patel, Bela; Paxton, James H; Hanley, Daniel F; Rijnders, Bart J A; Gharbharan, Arvind; Rokx, Casper; Zwaginga, Jaap Jan; Alemany, Andrea; Mitjà, Oriol; Ouchi, Dan; Millat-Martinez, Pere; Durkalski-Mauldin, Valerie; Korley, Frederick K; Dumont, Larry J; Callaway, Clifton W
- Abstract
Background Outpatient monoclonal antibodies are no longer effective and antiviral treatments for coronavirus disease 2019 (COVID-19) disease remain largely unavailable in many countries worldwide. Although treatment with COVID-19 convalescent plasma (CCP) is promising, clinical trials among outpatients have shown mixed results. Methods We conducted an individual participant data meta-analysis from outpatient trials to assess the overall risk reduction for all-cause hospitalizations by day 28 in transfused participants. Relevant trials were identified by searching Medline, Embase, medRxiv, World Health Organization COVID-19 Research Database, Cochrane Library, and Web of Science from January 2020 to September 2022. Results Five included studies from 4 countries enrolled and transfused 2620 adult patients. Comorbidities were present in 1795 (69%). The virus neutralizing antibody dilutional titer levels ranged from 8 to 14 580 in diverse assays. One hundred sixty of 1315 (12.2%) control patients were hospitalized, versus 111 of 1305 (8.5%) CCP-treated patients, yielding a 3.7% (95% confidence interval [CI], 1.3%–6.0%; P =.001) absolute risk reduction and 30.1% relative risk reduction for all-cause hospitalization. The hospitalization reduction was greatest in those with both early transfusion and high titer with a 7.6% absolute risk reduction (95% CI, 4.0%–11.1%; P =.0001) accompanied by at 51.4% relative risk reduction. No significant reduction in hospitalization was seen with treatment >5 days after symptom onset or in those receiving CCP with antibody titers below the median titer. Conclusions Among outpatients with COVID-19, treatment with CCP reduced the rate of all-cause hospitalization and may be most effective when given within 5 days of symptom onset and when antibody titer is higher.
- Subjects
MEDICAL databases; RELATIVE medical risk; META-analysis; MEDICAL information storage &; retrieval systems; CONFIDENCE intervals; IMMUNOGLOBULINS; SYSTEMATIC reviews; PREVENTIVE health services; CONVALESCENT plasma; HOSPITAL care; DESCRIPTIVE statistics; MEDLINE; COVID-19 pandemic; OUTPATIENT services in hospitals; COMORBIDITY
- Publication
Clinical Infectious Diseases, 2023, Vol 76, Issue 12, p2077
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciad088